Clinical outcome analysis of single embryo transfer in patients with scarred uterus after cesarean
10.3760/cma.j.cn101441-20200831-00467
- VernacularTitle:剖宫产术后瘢痕子宫患者行单胚胎移植的临床结局分析
- Author:
Lin WANG
1
;
Feiyang DIAO
1
;
Jing WANG
1
;
Chunxiang WU
1
;
Jiayin LIU
1
Author Information
1. 南京医科大学第一附属医院生殖医学科 210029
- Publication Type:Journal Article
- Keywords:
Single embryo transfer;
Scarred uterus;
Cesarean scar defect;
Pregnancy outcomes
- From:
Chinese Journal of Reproduction and Contraception
2021;41(9):790-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of scarred uterus and cesarean scar defect (CSD) on the reproductive outcomes of patients with previous cesarean delivery undergoing single embryo transfer (SET).Methods:A retrospective cohort study was conducted to analyze the data of patients with a history of cesarean delivery (CD) who accepted SET between January 2016 and April 2018 in Reproductive Medicine Center of the First Affiliated Hospital, Nanjing Medical University. According to the previous mode of delivery, patients were divided into CD group and vaginal delivery (VD) group. The pregnancy outcomes were analyzed in each embryo stage respectively. Furthermore, according to embryonic development stage, patients were divided into cleavage-stage embryo group (CD1 group, n=928 and VD1 group, n=928) and blastocyst-stage embryo group (CD2 group, n=570 and VD2 group, n=480). The CD population were further divided into two groups according to the presence of CSD to investigate the effect of CSD on pregnancy outcomes. Results:Regardless of women undergoing transfer of a cleavage-stage embryo or a blastocyst-stage embryo, there were no statistical differences in live birth rate, pregnancy rate, implantation rate, abortion rate and premature birth rate between CD group and VD group (all P>0.05). Compared with VD group, the risk of gestational complications such as placenta previa, postpartum hemorrhage, gestational diabetes, and gestational hypertension were not significantly increased in CD group (all P>0.05). The live birth rate was lower in CSD group than in non-CSD group in women undergoing the transfer of blastocyst-stage embryo [30.00% (12/40) vs. 51.32% (272/530), P=0.013]. The pregnancy rate and the implantation rate were lower in CSD group than in non-CSD group in women undergoing the transfer of the cleavage-stage embryo [18.97% (11/58) vs. 32.30% (281/870), P=0.034; 18.97% (11/58) vs. 31.26% (272/870), P=0.049]. Conclusion:With SET strategy, patients with a history of cesarean section have similar pregnancy outcomes to those with VD, and there is no increased risk of perinatal complications. However, the pregnancy outcomes of in vitro fertilization-embryo transfer are hampered in women with CSD. Single blastocyst-stage embryo transfer strategy is recommended for patients with scarred uterus.
